Local Treatment in Patients Presenting with Stage IVc Head and Neck Squamous Cell Carcinoma
F Nguyen | N Basté
Seance of wednesday 21 march 2018 (Séminaire de cancérologie)
DOI number : 10.26299/4bg6-0010/emem.2018.1.002
Abstract
Head and neck squamous cell carcinoma patient presenting with distant metastasis stage IVc is rare, concerning 4.7% of patients in our experience. There are many questions unsolved regarding standard systemic treatment administration, as well as the feasibility and benefit of local treatment. However, there ais a strong rationale, in terms of tumor biology and empirical treatments, to treat the primary tumor in a curative setting. In the Institute Gustave Roussy experience, upfront curative treatment has been possible to be administered in 17% of patients. Median overall survival was 39 months, with 1-year and 5-year overall survival rates of 68% and 40.7%, respectively. In 70% of patients, no upfront curative treatment was feasible, thus a systemic therapy was initiated. 37% of these patients, so 26% of stage IVc patients, had a complete response to chemotherapy first, and could undergo a subsequent curative locoregional treatment. Median survival was 17 months for complete responders and 7 months for others, with 1-year and 5-year verall survival rates of 68.3% vs. 40.3% and 15.8 vs. 3.6%, respectively. 13% of stage IVc patients could not receive any oncological treatment and followed best supportive care. Median overall survival was 2 months, with 1-year and 5-year overall survival rates of 23% and 0%. In conclusion, 43% of stage IVc patients could receive a locoregional treatment in a curative intent. With the improvement of systemic therapy results, the development of immunotherapy treatments, and increased survival of patients with metastatic disease, preservation of quality of life should be considered a major criterion for treatment decision-making.